CNN's response to Michael Moore

In response to a letter Michael Moore wrote about CNN's reporting on his documentary "Sicko," a CNN spokesperson released the following statement:

"It's ironic that someone who has made a career out of holding powerful interests accountable is so sensitive to having his own work held up to the light by impartial journalists, as we did in our examination of 'Sicko,' " the spokesperson said.

"In our original report, we made one mistake, which we apologized for and corrected on air and online six days ago, despite Mr. Moore's claim yesterday in his letter to us. Further, the e-mail Mr. Moore released in an effort to cast doubt on our reporting does no such thing.

"We appreciate Mr. Moore's attention to the important subject of health care and have featured him on CNN four times to discuss his movie and our reporting on it. While Mr. Moore may want to continue the discussion in order to drive publicity to his movie, we have presented the facts and are comfortable letting the viewers judge for themselves.

"We have zero vested interest in shading the numbers to tell a certain story. Suggesting otherwise, of Dr. Gupta or of CNN, just doesn't hold water," the spokesperson concluded.

CNN has always prided itself on balanced reporting of claims made by special-interest groups. Moore's documentary "Sicko," which makes an impassioned case for a complete overhaul of the U.S. health care system, was not exempt from that reporting.

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Moore has been sharply critical of CNN's reporting on his movie. CNN gave him multiple opportunities to respond, including lengthy segments on "The Situation Room" and "Larry King Live." Portions of those segments were aired in other CNN programs.

Moore recently posted an open letter and two so-called "Truth Squad" statements on his Web site. This document responds to the specific points Moore lays out:

Dr. Sanjay Gupta, CNN: "(Moore says) the United States slipped to number 37 in the world's health care systems. It's true. ... Moore brings a group of patients, including 9/11 workers, to Cuba and marvels at their free treatment and quality of care. But hold on -- that (World Health Organization) list puts Cuba's health care system even lower than the United States, coming in at No. 39."

"The Truth" (from Michael Moore's Web site):

"But hold on? 'Sicko' clearly shows the WHO list with the United States at number No. 37 and Cuba at No. 39. Right up on the screen in big 5-foot letters. It's even in the trailer! CNN should have its reporter see his eye doctor. The movie isn't hiding from this fact. Just the opposite.

CNN RESPONSE:

Moore appears unhappy with Gupta's use of the phrase, "But hold on."

Moore appears to be creating an issue where none exists.

Gupta and Moore agree that the U.S. ranks 37th and Cuba ranks 39th on a WHO report. Gupta in his fact check says this is true.

And Gupta never said Moore didn't convey that Cuba was 39th, even though the verbal emphasis at that point in the movie is a comparison between the United States and Slovenia.

CNN: "Moore asserts that the American health care system spends $7,000 per person on health. Cuba spends $25 dollars per person. Not true. But not too far off. The United States spends $6,096 per person, versus $229 per person in Cuba."

As for Cuba -- Dr. Gupta and CNN need to watch "Sicko" first before commenting on it. "Sicko" says Cuba spends $251 per person on health care, not $25, as Gupta reports. And the BBC reports that Cuba's per capita health expenditure is... $251! (Keeping Cuba Healthy, BBC, August 1 2006). This is confirmed by the United Nations Human Development Report, 2006. Yup, Cuba spends $251 per person on health care. As Gupta points out, the World Health Organization does calculate Cuba's per capita health expenditure at $229 per person. We chose to use the U.N. numbers, a minor difference - and $229 is a lot closer to $251 than $25.

CNN RESPONSE:

CNN has corrected and apologized for an error in transcription in our report. We did so on television and online.

CNN had said that in the film Moore reported Cuba spends $25 per person for health care when the film actually reported that number to be $251. We regret that mistake.

However, we originally fact checked Moore's reporting because he uses numbers for each country from different reports and he compares a number that describes actual spending to a projection from another source.

He sources his number from Cuba to a BBC report. In that same BBC report, the number cited for U.S. spending is $5,711. Moore doesn't use that number, but instead a higher number found in another report (as cited by Moore above) from the Department of Health and Human Services' National Health Expenditures Projections. That projection is that the United States will spend $7,092 per capita on health in 2006 and $7,498 in 2007 (Department of Health and Human Services Center for Medicare and Medicaid Expenditures, National Health Expenditures Projections 2006-2016). Actual numbers for the years 2006 and 2007 are not yet available, which is why CNN could not use them.

We believe the most accurate comparison of statistics comes from analysis of numbers from the same report and the same year.

CNN used the WHO's World Health Statistics 2007 report for both the Cuban and U.S. data. That report uses the latest information on actual dollars spent, in this case from the year 2005. These summaries of actual expenditures -- not projections -- reported by CNN are: Cuba-$229, U.S.-$6,096.

Both of these numbers come from the same report and provide consistency under statistical analysis.

The only controversy here is within Moore's numbers. Moore uses $251 to describe Cuban health care spending in his movie, but when CNN e-mailed Moore's production company to verify numbers, his own staffer e-mailed back that $229 was the correct number.

As Gupta said, CNN's numbers and Moore's numbers aren't far off, but we believe ours are a fairer comparison.

Moore cites the 2006 United Nations Human Development Index, which uses life expectancy data from 2004. CNN relied on the 2007 World Health Organization report, which uses life expectancy data from 2005. That data shows Americans with a life expectancy of 77.9 years and Cubans with a life expectancy of 77.2 years.

Patients may be satisfied in America, but not everyone gets to be a patient. Forty-seven million are uninsured and are rarely patients -- until it's too late. In the rest of the Western world, everyone and anyone can be a patient because everyone is covered (And don't face exclusions for pre-existing conditions, co-pays, deductibles and costly monthly premiums).

Moore does not seem to have an issue with CNN's report on this point. Here's what Gupta actually said on the air:

"Sicko" Film clip: "The United States slipped to No. 37 in the world's healthcare systems..."

Gupta: "It's true. Thirty-seven is the ranking according to the World Health Organization's latest data on 191 countries. It's based on general health level, patient satisfaction, access and how it's paid for. France tops the list. Italy and Spain make it into the top 10. The United Kingdom is 18."

CNN: Americans have shorter wait times than everyone but Germans when seeking non-emergency elective procedures, like hip replacement, cataract surgery, or knee repair.

"The Truth" (from Michael Moore's Web site):

This isn't the whole truth. CNN pulled out a statistic about elective procedures. Of the six countries surveyed in that study -- United States, Canada, New Zealand, UK, Germany, Australia -- only Canada had longer waiting times than America for sick adults waiting to schedule a doctor's appointment for a medical problem. Eighty-one percent of patients in New Zealand got a same or next-day appointment for a non-routine visit, 71 percent in Britain, 69 percent in Germany, 66 percent in Australia, 47 percent in the U.S. and 36 percent in Canada ("The Doc's In, but It'll Be a While," Catherine Arnst, Business Week, June 22, 2007).

"Gerard Anderson, a Johns Hopkins health policy professor who has spent his career examining the world's health care, said there are delays, but not as many as conservatives state. In Canada, the United Kingdom and France, '3 percent of hospital discharges had delays in treatment,' Anderson told The Miami Herald. 'That's a relatively small number, and they're all elective surgeries, such as hip and knee replacement.' " (John Dorschner, 'Sicko' film is set to spark debate; Reformers are gearing up for 'Sicko,' the first major movie to examine America's often-maligned health care system," The Miami Herald, June 29, 2007).

One way America is able to achieve decent waiting times is that it leaves 47 million people out of the health care system entirely, unlike any other Western country. When you remove 47 million people from the line, your wait should be shorter. So why is the U.S. second to last in wait times?

CNN: (PAUL KECKLEY-Deloitte Health Care Analyst): "The concept that care is free in France, in Canada, in Cuba -- and it's not. Those citizens pay for health services out of taxes. As a proportion of their household income, it's a significant number ... (GUPTA): It's true that the French pay higher taxes, and so does nearly every country ahead of the United States on that list."

"The Truth" (from Michael Moore's Web site):

"Sicko" never claims that health care is provided absolutely for free in other countries without tax contributions from citizens. Former (member of the British Parliament) Tony Benn reads from the NHS founding pamphlet, which explicitly states that "this is not a charity. You are paying for it mainly as taxpayers." "Sicko" also acknowledges that the French are "drowning in taxes." Comparatively, many Americans are drowning in insurance premiums, deductibles, co-pays and medical debt and the resulting threat of bankruptcy -- half of all bankruptcies in the United States are triggered by medical bills (Medical Bills Make up Half of Bankruptcies, February 2005, MSNBC).

One of Gupta's overall critiques of the film is that Moore leaves viewers with an impression, as he does on his Web site, that universal health care comes without cost. In fact, substantial taxes are required to pay for such programs around the world.

The very same newsletter cited by Moore points out that complementary insurance "provides cover for services excluded or not fully covered by the state." The rates cited for complementary insurance in that newsletter show 85 percent of the French buys such policies, 9 percent of the Germans, 45 percent of the Irish, and 15.6 percent of the Italians. In Britain, 11.6 percent buy supplementary health insurance, which the newsletter says provides "cover for faster access and increased consumer choice."

CNN: "But no matter how much Moore fudged the facts, and he did fudge some facts..."

"The Truth" (from Michael Moore's Web site):

This is libel. There is not a single fact that is "fudged" in the film. No one has proven a single fact in the film wrong. We expect CNN to correct their mistakes on the air and to apologize to their viewers.

CNN RESPONSE:

Gupta believes picking and comparing numbers from different places and times to suit an argument is not the best approach to a complicated issue like this one. Again, as pointed out earlier, by mixing types of data and time periods in some of Moore's comparisons, Gupta felt that the film effectively fudged points that could have been made just as compellingly by comparing data from the same source and time period.

GUPTA: "Well, I mean, he pulls $251 from this BBC unsourced report ... Where you pulled the $251 number was a BBC report, which, by the way, stated that the per capita spending in the United States was $5,700. You chose not to use the $5,700 from one report and chose to go to a totally different report and you're sort of cherry picking data from different reports ... Well, why didn't you use the $5,700 number from the BBC report?"

"The Truth" (from Michael Moore's Web site):

Actually, the number "Sicko" cited for per-capita Cuban spending on health care -- $251, a number widely cited by the BBC and other outlets -- comes from the United Nations Human Development Report, helpfully linked on our Web site. Here it is again: http://hdr.undp.org/hdr2006/statistics/indicators/52.html.

That U.N. report does list American health care spending as only $5,700, but it's a few years old. Since then, the U.S. government has updated its projections for health care spending, to $7,498 in 2007. So we used that number. It's the most recent, and comes right from the Department of Health and Human Services. If the Cuban government gave a figure on 2007 projected health spending, we'd have used it.

CNN RESPONSE:

To reiterate, we believe numbers should be compared apples to apples, oranges to oranges. Moore himself says the data he's citing from the U.N. Development Programme is dated. Consistency is important in statistical analysis and is not present in Moore's comparison.

GUPTA: "Medicare is going to go bankrupt by 2019, and is going to be $28 trillion in debt by 2075 ... Look, I believe the very measure of a great society is in how we take care of those who cannot take care of themselves. But would you say that this is going to be still a working system 20 years from now?"

"The Truth" (from Michael Moore's Web site):

Medicare indeed has enough money to cover all seniors until 2019. At that time, it will simply need more funding. That shouldn't be hard to find in a nation spending trillions of dollars to invade other countries.

Medicare is not in trouble because it is socialized medicine. Medicare faces the same economic problem private health plans do -- health care inflation is out of control, far outpacing inflation for other goods and services. And in fact, Medicare is much more efficient at dealing with this inflation than is private insurance. According to the Center for Medicare and Medicaid Services (Table 13), per beneficiary costs have risen in nominal dollars by 519.5 percent since 1980. By contrast, the cost per enrollee of private insurance has risen by 676.6 percent over this same period. So Gupta should instead be pointing his finger at the inefficiency of private insurance (Social Security and Medicare Myths, Lies, and Realities. Institute for America's Future and "Gupta Says Medicare is Going Bankrupt," Dean Baker, Beat the Press) blog).

There is a clear way to make our health economy more efficient. We waste $400 billion dollars per year administering our mess of a private, profit-driven system. The answer is switching to a single-payer, Medicare-style system and taking absurd profits and administrative costs out of the equation (Steffie Woolhandler, M.D., M.P.H., Terry Campbell, M.H.A., and David U. Himmelstein, M.D., Costs of Health Care Administration, N Engl J Med 2003;349:768-75 ).

CNN RESPONSE:

Again, Moore seems to be creating controversy where there is none. Moore agrees with Dr. Gupta's reporting that Medicare solvency is only assured until 2019.

GUPTA: (On the lone expert shown in the original piece, Paul Keckley). "His only affiliation is with Vanderbilt University. We checked it, Michael. We checked his conflict of interest. We do ask those questions."

Keckley has made large contributions to Republican candidates and organizations. He gave $1,000 to GOP Senator Bob Corker in 2006, $1,000 to the Tennessee GOP in 2002, along with $1,500 to two GOP congressional candidates and $1,000 to the Tennessee GOP in 2000 (www.fecinfo.com).

Keckley was also the CEO and Founder of EBM Solutions Inc., of Nashville, Tennessee, which counted among its customers Blue Cross of Tennessee, the drug company Aventis and others. Considering Keckley makes his living in the for-profit health care world -- a world "Sicko" argues should be abolished -- viewers should have been told exactly where Keckley was coming from.

CNN RESPONSE:

Moore is correct. Paul Keckley left Vanderbilt in late 2006. That is the affiliation Gupta referenced on "Larry King Live." In addition, CNN obtained the following details about Paul Keckley from his current employer, Deloitte Center for Health Solutions:

"The original CNN report accurately described Paul Keckley's role as a Deloitte health care expert. Keckley is executive director of the Deloitte Center for Health Solutions. He left Vanderbilt University in October 2006 to take this new position.

"The comments by Keckley in the CNN interview were factual, neutral and descriptive. The accuracy of his balanced comments in the broadcast has not been challenged.

"Neither the Deloitte Center for Health Solutions nor Paul Keckley has a political or ideological agenda. The center's mission is to develop innovative, practical and workable solutions to systemic issues of the U.S. health system. As such, it embraces a diversity of viewpoints that transcend easy labels.

"Keckley as an individual and Deloitte as an organization operate under rigorous rules, government regulations and professional standards designed to ensure his and our independence.

"The center has been an active participant in the national dialogue about the critical challenge America faces to preserve the best that our health care system delivers -- while at the same time seeking ways to provide coverage for the uninsured, promote wellness and prevention, deploy more effective information technology to improve patient outcomes, and reduce soaring health care costs.

"One example of how the Deloitte Center's approach is a report issued in late 2006 titled, 'The Catalyst for Health Care Reform: Providing More Choices and Innovation to Heal the U.S. Health Care Financing System.' In addition to providing a thoughtful and comprehensive overview of the key issues, it presented one possible, innovative approach to solving health care coverage for America's [46] million uninsured citizens. It reflects the serious, thoughtful and independent nature of the Deloitte Center.

'Keckley does not maintain any professional or financial ties to Aventis or Blue Cross. From 1998-2002, Keckley did serve as CEO of EBM Solutions, a private company formed by researchers from Vanderbilt, Duke, Emory, Washington University and Oregon Health Sciences University. EBM developed and licensed evidence-based guidelines to 32 hospitals, medical groups, insurance companies and drug companies during this period. Among those licensing these guidelines were Aventis and Blue Cross of Tennessee.

CONCLUSION

CNN has long been committed to covering health care issues in the United States and around the world. During the same period that Michael Moore has been working on his movie, CNN has aired hours and hours of health care related reporting. Topics included: lack of insurance, under-insurance, quality of care, access to care, problems with drugs and inappropriate ties between drug companies and lawmakers. Just this week, CNN aired a second investigative piece on hospitals that dump homeless patients onto Los Angeles' skid row.

Gupta lives with the painful problems of the health care industry every day. He is a practicing physician, serving as a neurosurgeon for the past five years at a large indigent-care hospital. His experience as a White House fellow gave him a deep understanding of the political issues surrounding health care reform. For the last six years, Gupta has also worked as a journalist whose reporting on health care and health care issues is widely recognized for its objectivity and care.